Provider Demographics
NPI:1124272893
Name:LESLIE, LESLIE M (ACNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:LESLIE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 KEATING RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-2901
Mailing Address - Country:US
Mailing Address - Phone:662-561-4002
Mailing Address - Fax:662-561-4050
Practice Address - Street 1:155 KEATING RD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2901
Practice Address - Country:US
Practice Address - Phone:662-561-4002
Practice Address - Fax:662-561-4050
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866883363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care